In the 273 occurrences examined in this study, misunderstanding between the pilot and master, inattention by the pilot or the OOW, or lack of communication between the pilot and the OOW were frequently present. The complexity of the master/pilot relationship was highlighted by the often conflicting opinions given by masters, OOWs and pilots in response to the TSB's questionnaire. The vast majority of responding masters, bridge officers and pilots believe that teamwork is as important as technical proficiency for safe navigation. Recent occurrences indicate continuing problems with respect to the adequacy of bridge teamwork; e.g. lack of a mutually agreed passage plan, lack of interaction, coordination and cooperation among the bridge team, lack of precise progress-monitoring by the OOW, etc. Fundamental differences in the corporate perspectives of ship officers and pilots on such issues as the need for compulsory pilotage and limited pilots' legal liability are not conducive to promoting harmony in bridge teamwork. Although most pilots, masters and OOWs agree that improving communications among bridge personnel is key to safe marine operations, a significant proportion of masters and bridge officers reported reluctance to question a pilot's decisions. Often, there are differences in perceptions between masters/OOWs and pilots regarding the need for the exchange of information and the adequacy of the information being exchanged. Most masters and bridge officers who responded to the questionnaire state that they always inform the pilot of the manoeuvring characteristics of the vessel, but few pilots state that they are always provided with the information. The majority of masters and bridge officers feel that pilots do not always provide adequate timely information on local conditions. Pilots reported that masters on foreign vessels who are regular visitors in Canadian waters know the local conditions well enough. Many masters and bridge officers reported that pilots do not always provide information to the master or the OOW regarding the passage plan; most pilots claim that they do. Pilots and masters also disagree over the adequacy of hand-over briefings; most masters/OOWs say that they are informative and most pilots say that they are not. Many masters and OOWs believe that pilots do not always convey information essential to safe navigation which is received by radio communications. With respect to the overall exchange of information between pilots and masters and OOWs, apparently each party is under the assumption that the other knows the necessary information and, if they do not, they will request it. Misperceptions that the other party knows about the manoeuvring characteristics of the vessel, or the local conditions and the intended passage plan can lead to significant misunderstandings and surprises for the bridge team. Since 1975, there have been at least 24 marine occurrences involving foreign-flag vessels in Canadian pilotage waters where an inadequate knowledge of the operating language was identified as a contributing factor. A majority of pilots reported that language barriers sometimes prevent effective communication with the master and the OOW; several reported that language barriers often prevented it. Pilots and bridge officers disagree on the extent to which OOWs monitor the vessel's progress, the pilots expressing some dissatisfaction with respect to how well they are being supported or monitored by bridge personnel. However, both groups agree that the pilots seldom assist the OOW in monitoring the vessel movements. Most of the foregoing findings are indicative of serious barriers in the relationship among pilots, masters and OOWs, thereby compromising their effectiveness as a coherent team. Several foreign organizations have recognized the relationship between crew interaction and accident causation, and have begun implementing various training regimes in Bridge Resource Management (BRM). Training for Canadian ship masters, bridge officers and pilots concentrates on technical proficiency. No initial or recurrent training in bridge teamwork is required to retain a valid operating certificate in Canada.3.0 SUMMARY OF FINDINGS In the 273 occurrences examined in this study, misunderstanding between the pilot and master, inattention by the pilot or the OOW, or lack of communication between the pilot and the OOW were frequently present. The complexity of the master/pilot relationship was highlighted by the often conflicting opinions given by masters, OOWs and pilots in response to the TSB's questionnaire. The vast majority of responding masters, bridge officers and pilots believe that teamwork is as important as technical proficiency for safe navigation. Recent occurrences indicate continuing problems with respect to the adequacy of bridge teamwork; e.g. lack of a mutually agreed passage plan, lack of interaction, coordination and cooperation among the bridge team, lack of precise progress-monitoring by the OOW, etc. Fundamental differences in the corporate perspectives of ship officers and pilots on such issues as the need for compulsory pilotage and limited pilots' legal liability are not conducive to promoting harmony in bridge teamwork. Although most pilots, masters and OOWs agree that improving communications among bridge personnel is key to safe marine operations, a significant proportion of masters and bridge officers reported reluctance to question a pilot's decisions. Often, there are differences in perceptions between masters/OOWs and pilots regarding the need for the exchange of information and the adequacy of the information being exchanged. Most masters and bridge officers who responded to the questionnaire state that they always inform the pilot of the manoeuvring characteristics of the vessel, but few pilots state that they are always provided with the information. The majority of masters and bridge officers feel that pilots do not always provide adequate timely information on local conditions. Pilots reported that masters on foreign vessels who are regular visitors in Canadian waters know the local conditions well enough. Many masters and bridge officers reported that pilots do not always provide information to the master or the OOW regarding the passage plan; most pilots claim that they do. Pilots and masters also disagree over the adequacy of hand-over briefings; most masters/OOWs say that they are informative and most pilots say that they are not. Many masters and OOWs believe that pilots do not always convey information essential to safe navigation which is received by radio communications. With respect to the overall exchange of information between pilots and masters and OOWs, apparently each party is under the assumption that the other knows the necessary information and, if they do not, they will request it. Misperceptions that the other party knows about the manoeuvring characteristics of the vessel, or the local conditions and the intended passage plan can lead to significant misunderstandings and surprises for the bridge team. Since 1975, there have been at least 24 marine occurrences involving foreign-flag vessels in Canadian pilotage waters where an inadequate knowledge of the operating language was identified as a contributing factor. A majority of pilots reported that language barriers sometimes prevent effective communication with the master and the OOW; several reported that language barriers often prevented it. Pilots and bridge officers disagree on the extent to which OOWs monitor the vessel's progress, the pilots expressing some dissatisfaction with respect to how well they are being supported or monitored by bridge personnel. However, both groups agree that the pilots seldom assist the OOW in monitoring the vessel movements. Most of the foregoing findings are indicative of serious barriers in the relationship among pilots, masters and OOWs, thereby compromising their effectiveness as a coherent team. Several foreign organizations have recognized the relationship between crew interaction and accident causation, and have begun implementing various training regimes in Bridge Resource Management (BRM). Training for Canadian ship masters, bridge officers and pilots concentrates on technical proficiency. No initial or recurrent training in bridge teamwork is required to retain a valid operating certificate in Canada.